Provider Demographics
NPI:1114540192
Name:MOORE, TERESA (LPCS)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:LPCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 FRESNO ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:79072-7131
Mailing Address - Country:US
Mailing Address - Phone:896-729-6459
Mailing Address - Fax:
Practice Address - Street 1:815 FRESNO ST
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:TX
Practice Address - Zip Code:79072-7131
Practice Address - Country:US
Practice Address - Phone:896-729-6459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-25
Last Update Date:2020-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70228101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional